NYC EMS Low Pay Drives Attrition And Emergency Delays
Reading a Stranger’s Face From the Doorway
The call comes in as respiratory distress, and Natasha Villaruel, a paramedic, has about 20 seconds to make a life-saving decision. She is 36, born in Jamaica, in Brooklyn since she was four. Vitals get read from the doorway before anyone touches the patient: how the chest rises, how the words come out, what color the skin has gone. “The first thing you want to know is if they can speak, because now if they can’t speak, you know this is very, very urgent,” she says. [2] The rest is speed without recklessness — “You respond with lights and sirens safely. You try to get there as fast as you can” — and a judgment call made before the ambulance doors are even open: “Within 20 seconds, you have to make a life decision.” More than 4,500 EMS workers answer over 1.9 million medical and fire emergencies each year across the five boroughs, making life-and-death decisions for a city of more than 8.58 million people. [1] They rank among the lowest-paid first responders New York employs.
The pay ladder for the job is short and the rungs sit close together. An FDNY EMT starts at $39,386 a year, barely above New York City’s minimum wage. [1] After five years, an EMT can earn roughly $59,534. A firefighter with similar years of experience makes as much as $105,146 — nearly double. [1] Same city, same years of service, nearly twice the money; the variable is the uniform. That gap is the basis for the union’s demand for pay parity.
For Villaruel, the household math works only because her husband is a firefighter. Her colleagues are not so shielded. “We have people that live in shelters,” she says. “We have people that get vouchers. We have people that get food stamps.”
The Roster Thinned, the Clock Slowed
Oren Barzilay’s advice turned around before the numbers did. He spent 31 years in New York City’s emergency medical services and retired as president of FDNY EMS Local 2507. Young people now hear the opposite of a recruiting pitch: “Don’t come here,” he tells them. “You are only going to hurt yourself.” What changed was not his view of the work or the value of service, but his conclusion about what the city is willing to pay the people who risk their lives to save others. His own case is the illustration he offers — “After 31 years, I am stuck at $59,000.” [2] The roster thinned first, and the data marks the moment. According to a New York State EMS workforce report, the number of active EMS responders fell 17.5% between 2019 and 2022 statewide. [1] Anthony Almojera, an FDNY EMS paramedic lieutenant and vice president of Local 3621, describes the consequence without decoration: “We have a tremendous attrition problem. People are leaving.” [2].” The political record runs back further than the current fight. Sandy Nurse, a Brooklyn councilmember who has supported efforts to raise EMS compensation, puts the baseline bluntly: “EMS workers, frontline emergency management workers, make very, very low wages.” [2].” Then the clock moved. The average ambulance response time rose from 11 minutes and 21 seconds in fiscal year 2025 to 13 minutes and 9 seconds in fiscal year 2026, according to the Mayor’s Management Report. [1] For some patients, those minutes can be life-altering. “Time matters a lot,” says Dr Shreya Kashyap, a second-year neurology resident at Mount Sinai, who points to the phrase drilled into her field: “It’s called ‘time is brain.’” [2]
Promises From the Picket Line, Arithmetic at the Table
The wage fight has become an early test of a contradiction inside the Mamdani administration. As a candidate, Mamdani built part of his political identity around organized labor, affordability and demands that employers pay workers more. As mayor, he sits on the other side of the bargaining table, responsible for a vast municipal workforce and a finite city budget. The tension has already reached court: the administration filed a lawsuit to stop $10,000 payments to public-school paraprofessionals.
Kenneth Londono, communications director for the mayor’s office of labor relations, said in a statement: “Contract negotiations are currently underway with the EMS union, and we remain fully committed to good-faith bargaining at the table.” He said the administration hopes to reach a “fair and sustainable outcome” that supports EMS workers while “remaining fair to city taxpayers.” [2].” Barzilay is not persuaded. Asked whether he believes good-faith negotiations are happening under the new administration, he answers: “No. Not as of yet.”
Almojera is more hopeful and reads the administration as making a genuine effort. “Negotiations haven’t formally commenced,” he says. “We’re just talking. You know, just talking back and forth.” His reason for optimism has a name. Mamdani appointed Lillian Bonsignore as fire commissioner; she spent 31 years in FDNY EMS, beginning as an EMT before becoming a paramedic and eventually chief of EMS operations. “Making her commissioner is acknowledging that the Fire Department is mostly EMS,” Almojera says. “She knows exactly what we do. She’s one of us.” [2] Bonsignore’s office did not respond to a request for comment.
Villaruel’s patience is thinner. “I feel like politicians are politicians,” she says. “They tell you what you want to hear. And then when it’s time for the work to be put in, everyone is blind and deaf.” What pushes her colleagues out the door is not the sirens, not the hours, not the calls that end badly: “It’s not like they don’t like the job. It’s the pay that’s the problem.” And then the question that closes the case: “Who doesn’t like saving people?” The answer is a plastic card, the same size as the certification card in a paramedic’s pocket. One says its holder is qualified to make a life-or-death decision in 20 seconds. The other is a food stamp card or a rental voucher. Both are carried by New York City first responders.